Commentary on VA shake-up:Inadequate performance measures; Congress must do its part; similarities to Medicare

Media outlets offer opinions on Gen. Eric Shinseki's departure from the Department of Veterans Affairs and efforts to fix problems in that system.

Los Angeles Times: The Problem At The VA: 'Performance Perversity'
The acting inspector general's investigation into delays at Veterans Health Administration facilities points to problems so systemic that they cannot be attributed to a few bad apples. But the report does not tell us why these problems occurred. The most likely answer is "performance perversity": Imperfect performance measures were tied to pay incentives. Such performance incentives have been portrayed as the best way to manage all kinds of public services, even as evidence of their problems mount (Donald Moynihan, 6/1).

The Washington Post: Will Congress Be As Brave As Shinseki?
If you want a prime example of what's wrong with our politics, study the response to the veterans' health-care scandal. You would think from the coverage that the only issue that mattered to politicians was whether Gen. Eric Shinseki should be fired. Shinseki is a true patriot, and his resignation as Veterans Affairs secretary on Friday calls Congress's bluff. He played his part in a Washington sacrificial ritual. Will the politicians now be honorable enough to account for their own mistakes? (E.J. Dionne Jr., 6/1).

The Washington Post: VA Reforms Should Preserve The System's Quality Of Care
It is clear, though, from a reading of the report by the department's Office of Inspector General -; the 19th report issued since 2005 about delays and scheduling issues -; that it will take more than a ritual resignation and the election-year posturing that accompanied it to resolve the systemic issues that have long plagued the VA (5/31).

The Washington Post: Did Shinseki Fail His Underlings By Trusting Them Too Much?
To many in the trenches of the vast and decentralized VA system, Shinseki was seen as "the good guy everybody knew was trying to help," [retired psych nurse Janet] Nickolaus said. But of course, that undercover drop-by she hoped for never happened. And so much bad news was covered up that Shinseki resigned Friday over a widespread conspiracy to hide long wait times for military veterans seeking care. It's often said that an organization's tone is set at the top -; and that person sends employees a message of either fear or safety about speaking up to voice concerns (Melissa Henneberger, 5/31).

USA Today: At VA, Now Comes The Hard Part: Our View
But the bad news about waiting times was in fact flagged repeatedly by VA watchdogs going back to 2005. In 2009, the Office of Inspector General said it listed the problem as one of the "hot issues" for the then-new Obama administration to handle. ... Other problems may require an overhaul of VA management and certainly of VA thinking. ... The administration will need to find new leaders who have experience in the private sector, who are proven managers, who know how to run hospitals or huge academic institutions. Their job will not only be fixing what's broken but to change the culture to ensure against a relapse (6/1).

USA Today: After Shinseki's Misrule, VA Needs Accountability: Column
The VA is more than one man, and it's important to remember that the secretary's departure is not the final word on the VA's woes. This should not be seen as an end, but a beginning. Now comes the hard work of turning around a deeply troubled agency. For the last several weeks, it looked as if the VA was hoping to "run out the clock" on this scandal. The thinking appeared to be that if Shinseki and the rest of the status quo leadership could simply hang on, the uproar over falsified records, secret wait lists, destroyed documents, preventable patient deaths and corrupt bonuses paid to VA executives would subside, and the media spotlight would shift elsewhere (Darin Selnick, 5/30).

The Wall Street Journal's Washington Wire: What The VA Scandal And Medicare Cost Issues Have In Common
The federal government adjusts its payment policies, the health-care system tailors its practices to meet those new policies, and a variety of unexpected-;and perverse-;consequences result. This isn't just one aspect of the VA scandal. It also describes the effects of physician payment policies in Medicare. In the case of the Department of Veterans Affairs, decisions to tie performance bonuses to patient waiting times apparently resulted in attempts to manipulate the appointment system. Incidents reported in Pennsylvania, Wyoming and New Mexico illustrate how compensation and bonuses drove decisions about patient care (Chris Jacobs, 5/30).

The Wall Street Journal: Real Accountability At The VA
If failure is an orphan, Eric Shinseki is now Oliver Twist. The Veterans Affairs Secretary did the honorable thing and resigned on Friday, and the White House is hoping this will plug its political leak. But the next President, and the ones after that, will endure more VA scandals without more reform than President Obama is offering. Mr. Obama said he only reluctantly accepted Mr. Shinseki's exit so he would not be "a distraction" from fixing the VA-;and until this week the cable-TV carnival over his status was mostly that. But the Inspector General's preliminary findings reveal a systematic and perhaps criminal conspiracy to falsify wait-time records across dozens of hospitals and clinics (5/30).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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